Treatment of Renal Stones by Extracorporeal Shockwave Lithotripsy

Abstract

Aim: Despite the extensive experience with minimal invasive stone therapy, there are still different views on the ideal management of renal stones. Materials and Methods: Analysis of the literature includes more than 14,000 patients. We have compared these data with long–term results of two major stone centers in Germany. The results have been compared concerning the anatomical kidney situation, stone size, stone localization and observation time. Results: According to the importance of residual fragments following extracorporeal shock wave lithotripsy (ESWL), we have to distinguish between clinically insignificant residual fragments and clinically significant residual fragments (CIRF). 24 months following ESWL stone passage occurs as a continous process, and if there are no clinical symptoms, any endoscopic procedure should be considered as overtreatment. According to these results, stone–free rates of patients increase in longer follow–up periods. Newer ESWL technology has increased the percentage of CIRF. Conclusion: We consider ESWL in most patients with renal calculi as first–line treatment, except in patients with renal calculi bigger than 30 mm in diameter.

The impact of pelvicalyceal anatomy on the stone formation in patients with lower pole renal stones

“…[14,15,20]. Sampaio et al [18,19] first described the impact of the lower pole anatomy on post-ESWL stone clearance and suggested that lower pole IPA below 90° decreased the stone-free rate post the ESWL.…”

Residual fragments after percutaneous nephrolithotomy

“…The sensitivity of the UHCT was almost 100% compared to 47.6% for KUB, 89.2% for linear tomography and 67.8% for US (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). UHCT, despite its high sensitivity and specificity in stone detection, is not perfect.…”

Bilgisayarlı Tomografi İle Üriner Sistem Taşlarının Yapısı Tahmin Edilebilir Mi?

“…'ları in vitro yürüttükleri bir çalışmada BT attenüasyon değerlerini kullanarak taş yapısının %64-81 doğ-ruluk oranıyla belirlenebileceğini göstermişlerdir (20). Ürik asit, sistin, kalsiyum oksalat monohidrat ve brusit taşları in vitro olarak %85'in üzerinde doğruluk oranıyla gösterilebil-miştir (20)(21)(22)(23). Ancak in vivo şartlarda taş yapısını ayırmak daha zor ve daha az güvenilirdir.…”